Diabetes is the fourth leading cause of death in the world (Leak, Houchin and Shea, 2011). Treatment and management of this disease and its complications is also very costly, and it keeps rising. Therefore, most diabetic patients opt to self-manage this condition through such things as healthy eating, continuous physical activity, medication adherence, as well as regularly monitoring their blood glucose levels (Hayes et al., 2008). It is primary role of nurses to encourage and promote healthy lifestyles for all their patients (Hayes et al, 2008). However, nurses face constant challenges on how to effectively educate diabetes patients on how to self-manage the condition (Leak, Houchin and Shea, 2011). This paper will therefore look into diabetes self-management and the nurses’ role in assisting their patients to self-manage diabetes.
Self-management refers to the process and ability that an individual employs in the attempt to take control of their disease, as opposed to being controlled by it (Richard and Shea, 2011). This ability is increased by the contribution of healthcare professionals, the community, and family members in symptoms, lifestyle changes, the inevitable consequences of the disease, and also treatments (Richard and Shea, 2011). The self-management process comprises of observing one’s health and incorporating strategies meant to manage medication and treatment, symptoms, safety, and other disease implications (Richard and Shea, 2011).
For there to be effective management of these chronic health conditions, decisions have to be made in relation to sustaining physiologic stability and response to symptoms (Richard and Shea, 2011). About 99% of all diabetes care is self-administered by the patients, through physical and dietary lifestyle modifications (Leak, Houchin and Mabrey, 2009). These patients also require all the information that can help them be aware of all the consequences of managing diseases poorly. This way, they can adopt an involved, active, and informed approach towards managing their disease.
Nurses are the primary source of information for diabetes patients (Stiles, 2011). They should therefore be properly trained on how to handle patients who need education regarding self-management (Funnell and Weiss, 2008). Moreover, since self-management requires constant nurse-patient relationship, this relationship should never be underestimated (Stiles, 2011). It is therefore necessary that nurses have effective communication skills that help them develop and maintain this relationship. Nurses therefore have the legal and ethical duty to understand patient communication needs, and thus supply them with health information in ways that they can easily understand (Stiles, 2011).
Nurses are responsible for instructing patients prior to discharge to guarantee that they are well-informed. When it comes to providing the relevant information to the clients, nurses should ensure that they answer all patient questions and concerns (Leak, Houchin and Mabrey, 2009). For example, most patients are usually afraid that the kind of foods they are recommended to eat may be out of their reach (Leak, Houchin and Mabrey, 2009). They therefore just ignore those foods and go back to the foods they are used to. However, nurses can take charge and help change this misconception by giving the patients other alternatives that are more affordable and attainable (Leak, Houchin and Mabrey, 2009).
Nurses should also instruct the patients and demonstrate to them which foods choices are carbohydrate-consistent, portion-controlled, and heart-healthy (Leak, Houchin and Mabrey, 2009). Moreover, nurses can advice those patients who like eating out on the restaurants that will best address their new diets, so that the patients do not feel left out (Stiles, 2011). Moreover, patients need more guidance on which foods to avoid, and the best patterns to follow as they take their meals. For instance, nurses should ensure that they have made it clear that diabetes patients should avoid fruit juices, sweet tea, or soda between meals; as such sweet drinks have an effect on their blood glucose levels (Leak, Houchin and Mabrey, 2009).
Various programs are established to promote self-management (Stiles, 2011). These programs act as interventions to patients in that they facilitate the patients’ capabilities to self-monitor their symptoms and be more active in decision-making regarding the management of their health (Leak, Houchin and Mabrey, 2009). These programs are usually disease specific, such as diabetes self-management programs. The interventions comprise of role-playing, teaching, psychological support, use of information technology, and medical care (Leak, Houchin and Mabrey, 2009). However, the success of self-management programs is not always obvious, but it is measured in terms of health outcomes such as quality of life, the use of health care resources, self-management behaviours, self-efficacy, use of medications, and general knowledge (Leak, Houchin and Mabrey, 2009).
Rigorous patient education is another commonly used strategy formulated to facilitate self-management of diabetes (Hayes et al., 2008). This has increasingly been associated with better patient outcomes for glycemic control. It is therefore imperative that patients get adequate information regarding self-monitoring their blood glucose levels, as it is the easiest way to manage diabetes (Leak, Houchin and Mabrey, 2009).
It is not enough for nurses to just give patients instructions on how to manage their diabetic conditions after discharge (Leak, Houchin and Mabrey, 2009). It is important for these healthcare professionals to go the extra mile and deal with each patient differently, since their condition can never be completely similar to someone else’s. In this regard, motivational interviewing (MI) (Leak, Houchin and Mabrey, 2009) is important so as to increase each patient’s internal motivation to improve their behaviour. MI is an approach that is patient-centered, and it encourages thorough discussion of the targeted behaviour changes (Leak, Houchin and Mabrey, 2009).
Patients are more likely to change their behaviours when they feel that it is of personal importance to them. They are also more likely to view the changes as more achievable and even appreciate the benefits that come from these changes more (Leak, Houchin and Mabrey, 2009). To achieve MI, nurses should be careful to ask questions in a way that does not seem intrusive to the patients. Individualized coaching is actually more effective, since there is the one-on-one interaction that can make a breakthrough easier to achieve (Leak, Houchin and Mabrey, 2009).
Although time to assess each patient individually may not be there, it is important to strive to reach and every one of them individually. This way, it is easier to come up with an exercise plan for each patient that is more likely to help them and to be followed than just giving a generalized exercise plan (Leak, Houchin and Mabrey, 2009). This way, it is much easier for the patients to self-manage their conditions, thus resulting in positive outcomes.
Moreover, the use of MI approach encourages patients to state their concerns about aspects of their lives that could make it difficult to change or improve their behaviour (Leak, Houchin and Mabrey, 2009). This way, nurses can help them come up with alternative ways of handling themselves that ensure that they are still in control of their diabetes (Leak, Houchin and Mabrey, 2009). When nurses have current knowledge of self-managing diabetes, they are more helpful when it comes to helping their patients better manage diabetes.
At times, patients may not really grasp what self-management comprises of, and they may not ask for clarification (Stiles, 2011). This may be due to lack of understanding and low literacy levels of diabetes management. Nurses therefore have the responsibility of recognizing such individuals and explain the self-management concept in a language that these patients can easily derive what is required of them (Stiles, 2011). Nurses can also ask the patients to explain what they have learnt back to them in their own words (Stiles, 2011). This way, patients will have better understanding of managing their lifestyles so as to improve their glycemic control. By using these techniques, it will be easier to empower patients to make changes in their lives, as opposed to when the instructions given to patients are difficult to follow (Stiles, 2011).
As much as nurses would want to help their patients self-manage their conditions, patients must also show the initiative to be helped (Funnell and Weiss, 2008). They can do this by fully participating in the creation of their self-management plans (Funnell and Weiss, 2008). These individualized plans on self-management that emphasize on patient involvement are more effective in helping diabetic individuals deal better with the disease once they leave the hospital (Funnell and Weiss, 2008).
For quite a number of diabetes patients, giving them written instructions on what to do upon discharge is not enough (Stiles, 2011). This is due to the fact that they may be medically illiterate (Stiles, 2011), and grasping written information may be impossible for them. Moreover, these patients face the disadvantage of not being able to access information relating to self-management of diabetes regularly (Stiles, 2011). They may even fail to book or attend medical appointments, collect prescriptions, or even add onto their knowledge on diabetes. To make matters worse, the complicated medical jargon does not help.
It is therefore imperative to assist these medically illiterate patients understand what measures they are required to take to manage their diabetes condition (Stiles, 2011). Nurses are therefore the ones left with this responsibility. In such case, simple verbal information is more useful to the patients as opposed to complex written information (Stiles, 2011). Moreover, arranging the information into manageable units that follow one another can help the patients understand it better.
Additionally, it is important to simplify the healthcare system’s processes, policies, and procedures (Stiles, 2011). This way, patient knowledge increases, while their ability to understand and cope with their condition also increases (Stiles, 2011). When a patient does not understand what they are expected to do, they tend to be rude, harsh, and may even end up verbally assaulting the nurses attending to them (Stiles, 2011).
Illiterate patients are also quite likely to be at higher risks of hypoglycaemia, which makes them more vulnerable (Stiles, 2011). This makes them necessitate more assistance when going through hypoglycaemic episodes. Furthermore, failing to understand diabetes makes these patients feel disempowered, experience worse physical health, and also end up having lower life expectancy (Stiles, 2011).
Although providing patients with the relevant information is important, nurses cannot force them to follow it; they can only motivate them (Funnell and Weiss, 2008). Nurses should therefore have skills such as goal-setting, problem-solving, and active listening (Funnell and Weiss, 2008). Since most patients end up feeling guilty when they fail to comply with the self-care recommendations they have been given, it is the nurses’ responsibility to encourage them to work on themselves instead of just giving up (Funnell and Weiss, 2008).
Nurses have the obligation to assess the stage of change a patient is in, how important change is to the patient’s life context (Hayes et al., 2008), the confidence a patient has about being able to change, and the patient’s readiness to change their behaviours. Moreover, nurses should follow through in helping their patients maintain their course of change by regularly providing them with the necessary information, building relationship and support, reinforcing and rewarding them for success, and assisting the patients get back on track should they relapse (Hayes et al., 2008).
Bibliography
Richard, A.A. and Shea, K. 2011. Delineation of Self-Care and Associated Concepts. Journal of Nursing Scholarship, 43(3), pp 255-264.
Leak, A., Davis, E.D., Houchin, L.B. and Mabrey, M. 2009. Diabetes Management and Self-Care Education for Hospitalized Patients with Cancer, Clinical Journal of Oncology Nursing, 13 (2), pp 205-210.
Stiles, E., 2011. Promoting Health Literacy in Patients with Diabetes. Nursing Standard, 26 (8). pp 35-40.
Hayes, E., McCahon, C., Panahi, M.R., Hamre, T. and Pohlman, K. 2008. Alliance not Compliance: Coaching Strategies to improve Type 2 diabetes Outcomes. American Academy of Nurse Practitioners, 20. pp 155-162.
Funnell, M.M., Weiss, M.A., 2008. Patient Empowerment: The LIFE Approach. Eur Diabetes Nursing, 5(2). pp 75-78.
